452 Patient Factors and Preferences in Decision for Sleep Surgery: A Qualitative Analysis

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A179-A179
Author(s):  
Allison Ikeda ◽  
Robin Marsh ◽  
Crystina McShay ◽  
Shireen Saini ◽  
Maya Sardesai ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Analysis ◽  
Lifestyle Modification ◽  
Apnea Hypopnea Index ◽  
Sources Of Information ◽  
Nasal Surgery ◽  
Sleep Surgery ◽  
Factors Influencing ◽  
Obstructive Sleep ◽  
Osa Treatment

Abstract Introduction Patients with obstructive sleep apnea (OSA) are offered many treatment options spanning the spectrum of lifestyle modification, device therapy, and surgery. Sleep surgery, while often effective, results in moderate morbidity and has variable effectiveness on OSA improvement. Little is known about what patients consider when choosing treatment. We aim to identify factors that influenced the decision for sleep surgery among adults with OSA. Methods We conducted semi-structured virtual interviews with patients (≥18 years) with OSA (apnea-hypopnea index ≥5 events per hour of sleep) who underwent sleep surgery at a tertiary academic center, querying patients about factors in their decision for OSA treatment. Interviews were audio-recorded, transcribed, and analyzed for thematic content. We anticipate enrolling 10–18 total participants based on previously reported sample size in specialty groups for thematic saturation in specialty groups (ie, when no new concepts or factors emerge from interviews). Here we report pilot qualitative analysis results. Results Of nine eligible patients, eight enrolled (mean +/- standard deviation age 45.8 +/- 13.4 years, 2 female/6 males). Four patients underwent nasal surgery only, two patients underwent staged procedures, one underwent pharyngeal surgery only, and the last underwent nasal surgery with tori removal. Patients reported decision making duration of days to years for scheduling surgery. Reasons for pursuing sleep surgery included fatigue, quality of life, work performance, and safety. Overarching thematic domains related to decision for surgery were (1) major concerns, (2) external factors influencing decision, and (3) retrospective satisfaction/regret with decision. Major concerns involved factors beyond surgeon’s control, such as anesthesia and postoperative pain management, not surgery itself. Family and friends were reported to be highly influential in the process, both in favor and against surgery. Social media features and celebrity patients with OSA heightened awareness of sleep surgery and set preconceived expectations. Patients were mostly satisfied with outcomes, despite unanticipated acute recovery challenges. Conclusion This pilot qualitative analysis identifies factors influencing patients’ OSA treatment decisions. Understanding patients’ major concerns and sources of information may help to guide physician counseling, set realistic expectations, offer peri-operative support, and better engage parents in shared decision-making for sleep surgery. Support (if any) None.

Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

2020 ◽  
Vol 103 (8) ◽  
pp. 725-728
Keyword(s):  
Bariatric Surgery ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lifestyle Modification ◽  
Apnea Hypopnea Index ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Objective Evidence

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽  
2021 ◽  
pp. 1-8
Author(s):  
Lifeng Li ◽  
Demin Han ◽  
Hongrui Zang ◽  
Nyall R. London
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Nasal Surgery ◽  
Subjective Sleep Quality ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

<b><i>Objective:</i></b> The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. <b><i>Methods:</i></b> Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. <b><i>Results:</i></b> By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (<i>p</i> &#x3c; 0.05), while the Apnea-Hypopnea Index (AHI) changed little (<i>p</i> = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all <i>p</i> &#x3c; 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (<i>p</i> &#x3c; 0.05), except with the AHI (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

scholarly journals Multilevel Sleep Surgery Including the Palate in Nonsyndromic, Neurologically Intact Children with Obstructive Sleep Apnea

OTO Open ◽  
2019 ◽  
Vol 3 (2) ◽  
pp. 2473974X1985147
Author(s):  
Jason E. Cohn ◽  
George E. Relyea ◽  
Srihari Daggumati ◽  
Brian J. McKinnon
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Tertiary Care ◽  
Case Series ◽  
T Test ◽  
Velopharyngeal Insufficiency ◽  
Apnea Hypopnea Index ◽  
Sleep Surgery ◽  
Obstructive Sleep ◽  
Neurologically Intact

Objective To examine the effects of multilevel sleep surgery, including palate procedures, on obstructive sleep apnea parameters in the pediatric population. Study Design A case series with chart review was conducted to identify nonsyndromic, neurologically intact pediatric patients who underwent either uvulectomy or uvulopalatopharyngoplasty as part of multilevel sleep surgery from 2011 through 2017. Setting A tertiary care, university children’s hospital. Subjects and Methods Unpaired Student t test was used to compare average pre- and postsurgical apnea-hypopnea index (AHI) and oxygen saturation nadir (OSN). Paired Student t test was used to compare the mean pre- and postsurgical AHI and OSN within the same patient for the effects of adenotonsillectomy (T&A) vs multilevel sleep surgery. Results In patients who underwent T&A previously, multilevel sleep surgery, including palate procedures, resulted in improved OSA severity in 6 (86%) patients and worsened OSA in 1 (14%) patient. Multilevel sleep surgery, including palate procedures, significantly decreased mean AHI from 37.98 events/h preoperatively to 8.91 events/h postoperatively ( P = .005). However, it did not significantly decrease OSN. Conclusion This study includes one of the largest populations of children in whom palate procedures as a part of multilevel sleep surgery have been performed safely with no major complications and a low rate of velopharyngeal insufficiency. Therefore, palatal surgery as a part of multilevel sleep surgery is not necessarily the pariah that we have traditional thought it is in pediatric otolaryngology.

Adenotonsillectomy for the Treatment of Obstructive Sleep Apnea in Children with Prader-Willi Syndrome: A Meta-analysis

2019 ◽  
Vol 162 (2) ◽  
pp. 168-176
Author(s):  
Chia-Hsuan Lee ◽  
Wei-Chung Hsu ◽  
Jenq-Yuh Ko ◽  
Te-Huei Yeh ◽  
Ming-Tzer Lin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Success Rate ◽  
Cochrane Review ◽  
Velopharyngeal Insufficiency ◽  
Apnea Hypopnea Index ◽  
Prader Willi Syndrome ◽  
Postoperative Changes ◽  
Obstructive Sleep ◽  
Osa Treatment

Objective Adenotonsillectomy outcomes in obstructive sleep apnea (OSA) treatment among children with Prader-Willi syndrome (PWS) remain unclear. This study aimed to elucidate the effectiveness of adenotonsillectomy in OSA treatment among children with PWS. Data Source PubMed, MEDLINE, Embase, and Cochrane Review up to February 2019. Review Methods The registry number of the protocol published on PROSPERO was CRD42015027053. Two authors independently searched the relevant database. Polysomnography outcomes in these children were examined, including net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum and mean oxygen saturation, the overall success rate for a postoperative AHI <1, and the overall success rate for a postoperative AHI <5. Results Six studies with 41 patients were analyzed (mean age, 5.0 years; 55% boys; mean sample size, 6.8 patients). All children had PWS and received adenotonsillectomy for the treatment of OSA. The AHI was 13.1 events per hour (95% CI, 11.0-15.1) before surgery and 4.6 events per hour (95% CI, 4.1-5.1) after surgery. The mean change in the AHI was a significant reduction of 8.0 events per hour (95% CI, −10.8 to −5.1). The overall success rate was 21% (95% CI, 11%-38%) for a postoperative AHI <1 and 71% (95% CI, 54%-83%) for a postoperative AHI <5. Some patients developed velopharyngeal insufficiency postoperatively. Conclusion Adenotonsillectomy was associated with OSA improvement among children with PWS. However, residual OSA was frequently observed postoperatively in these patients.

scholarly journals Apnea–hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea

Medicine ◽  
2017 ◽  
Vol 96 (5) ◽  
pp. e6008 ◽  
Author(s):  
Jun Wu ◽  
Guoqiang Zhao ◽  
Yunchuan Li ◽  
Hongrui Zang ◽  
Tong Wang ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Nasal Surgery ◽  
Obstructive Sleep

scholarly journals Do the turbinates play an important role in obstructive sleep apnea syndrome? – Our experience

2016 ◽  
Vol 6 (22) ◽  
pp. 93-98
Author(s):  
Nicoleta Dumitrescu ◽  
Raluca Enache ◽  
Codrut Sarafoleanu
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Apnea Hypopnea Index ◽  
Nasal Airflow ◽  
Nasal Surgery ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Apnea Syndrome

Abstract BACKGROUND. Nasal obstruction may trigger obstructive sleep apnea syndrome (OSAS) and it is considered to be a cofactor in its pathophysiology. However, the relation between cause and effect still remains a matter of debate. MATERIAL AND METHODS. 18 patients diagnosed with chronic hypertrophic rhinitis and obstructive sleep apnea syndrome were included in the present study. All patients underwent nasal surgery as the single treatment for their sleep breathing disorders. Rhinomanometric (total nasal airflow, logReff, logVR) and polygraphic parameters (apnea-hypopnea index - AHI, snore flags index – SFI) were evaluated pre- and 2 months postoperatively. RESULTS. There was a statistically significant difference between the values of the preoperative and postoperative total nasal airflow (p-value<0.0001). In case of AHI, there was a decrease in its value from 31.56 preoperatively to 30.03 postoperatively, but the difference was not statistically significant (p=0.937). The SFI, on the other hand, presented a significant decrease (p=0.05), from a mean value of 93.15 preoperatively to 56.02 after the surgery. The correlation of the total nasal airflow with AHI and SFI, revealed that nasal surgery had an important impact upon snoring characteristics (r=0.24) and less upon OSAS severity (r=0.21). CONCLUSION. The nasal cavity obstruction contributes less to OSAS, but still represents a disorder that needs to be corrected in case of such patients. Turbinates reduction surgery may be applied in the treatment of OSAS and combined with palate and/or tongue surgery.

scholarly journals Analysis of Metabolites Changes on Obstructive Sleep Apnea Patients After Multilevel Sleep Surgery

2020 ◽  
Author(s):  
Abdulmohsen Alterki ◽  
Shibu Joseph ◽  
Thangavel Alphonse Thanaraj ◽  
Irina Al-Khairi ◽  
Preethi Cherian ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Metabolic Status ◽  
Apnea Hypopnea Index ◽  
P Value ◽  
Upper Airways ◽  
Sleep Surgery ◽  
Post Surgery ◽  
Obstructive Sleep ◽  
Increased Risk

Background: Obstructive sleep apnea (OSA) is caused by partial or complete obstruction of the upper airways. Corrective surgeries aim at removing obstructions in the nasopharynx, oropharynx, and hypopharynx. OSA is associated with increased risk of various metabolic diseases. Our objective was to evaluate the effect of surgery on the plasma metabolome. Methods: This study included 39 OSA patients who underwent Multilevel Sleep Surgery (MLS). Clinical and anthropometric measures were taken at baseline and 5 months after surgery. Results: The mean Apnea Hypopnea Index (AHI) significantly dropped from 22.0 &plusmn; 18.5 events/hour to 8.97 &plusmn; 9.57 events/hour (p-Value &lt;0.001). The Epworth&rsquo;s sleepiness Score (ESS) dropped from 12.8 &plusmn; 6.23 to 2.95 &plusmn; 2.40 (p-Value &lt;0.001) indicating success of the surgery in treating OSA. Plasma levels of metabolites, phosphocholines (PC) PC.41.5, PC.42.3, ceremide (Cer) Cer.44.0, and triglyceride (TG) TG.53.6, TG.55.6 and TG.56.8 were decreased (p-Value&lt;0.05) whereas lysophosphatidylcholines (LPC) 20.0 and PC.39.3 were increased (p-Value&lt;0.05) after surgery. Conclusion: This study highlights the success of MLS in treating OSA. Treatment of OSA resulted in improvement in metabolic status that was characterized by decreased TG, PCs and Cer metabolites post-surgery indicating that the success of the surgery positively impacted the metabolic status of these patients.

Comparison of Traditional Upper Airway Surgery and Upper Airway Stimulation for Obstructive Sleep Apnea

2020 ◽  
pp. 000348942095317
Author(s):  
Colin Huntley ◽  
Maurits Boon ◽  
Samuel Tschopp ◽  
Kurt Tschopp ◽  
Carolyn M Jenks ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Upper Airway Stimulation ◽  
Sleep Surgery ◽  
Medical Centers ◽  
Academic Medical ◽  
Obstructive Sleep ◽  
Quality Life

Objective: To compare patients with moderate-severe obstructive sleep apnea (OSA) undergoing traditional single and multilevel sleep surgery to those undergoing upper airway stimulation (UAS). Study Design: Case control study comparing retrospective cohort of patients undergoing traditional sleep surgery to patients undergoing UAS enrolled in the ADHERE registry. Setting: 8 multinational academic medical centers. Subjects and Methods: 233 patients undergoing prior single or multilevel traditional sleep surgery and meeting study inclusion criteria were compared to 465 patients from the ADHERE registry who underwent UAS. We compared preoperative and postoperative demographic, quality of life, and polysomnographic data. We also evaluated treatment response rates. Results: The pre and postoperative apnea hypopnea index (AHI) was 33.5 and 15 in the traditional sleep surgery group and 32 and 10 in the UAS group. The postoperative AHI in the UAS group was significantly lower. The pre and postoperative Epworth sleepiness scores (ESS) were 12 and 6 in both the traditional sleep surgery and UAS groups. Subgroup analysis evaluated those patients undergoing single level palate and multilevel palate and tongue base traditional sleep surgeries. The UAS group had a significantly lower postoperive AHI than both traditional sleep surgery subgroups. The UAS group had a higher percentage of patients reaching surgical success, defined as a postoperative AHI <20 with a 50% reduction from preoperative severity. Conclusion: UAS offers significantly better control of AHI severity than traditional sleep surgery. Quality life improvements were similar between groups.

Polysomnographic Outcomes Before and After Skeletal Surgeries for the Treatment of Obstructive Sleep Apnea

2021 ◽  
Vol 104 (3) ◽  
pp. 445-452
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Success Rates ◽  
Maxillomandibular Advancement ◽  
Obstructive Sleep ◽  
Before And After ◽  
Hyoid Suspension ◽  
Group 2 ◽  
Osa Treatment

Objective: To evaluate polysomnographic (PSG) outcomes after common skeletal surgeries for the treatment of obstructive sleep apnea (OSA) in Thai patients. Materials and Methods: The retrospective study included OSA patients aged 18 years and older treated by hyoid suspension (HS) plus uvulopalatopharyngoplasty (UPPP) (Group 1), genioglossus advancement (GA) plus tongue base radiofrequency (TBRF) (Group 2), and maxillomandibular advancement (MMA) (Group 3) at Siriraj Hospital between January 2007 and October 2018. Those with incomplete PSG data were excluded. The primary outcome was the apnea-hypopnea index (AHI). Secondary outcomes were other PSG parameters and postoperative complications. Results: Twenty-four patients including 22 males and 2 females were included. Group1 (n=11), median AHI decreased from 45.4 to 24.1 events/hour (p=0.17), while lowest oxygen saturation (LSAT) changed from 72.0% to 71.0% (p=0.11). Group2 (n=3) median AHI decreased from 64.7 to 51.4 events/hour (p=0.11), LSAT increased from 76.0% to 79.0% (p=1.0), and rapid eye movement (REM) sleep increased from 0.0% to 12.4% (p=0.11). Group3 (n=12) median AHI decreased from 68.5 to 7.8 events/hour (p<0.002), LSAT increased from 75.5% to 88.0% (p=0.04), and REM increased from 0.0% to 21.5% (p=0.01). Surgical success rates as defined by Sher’s criteria or a postoperative AHI of less than five events/hour were 44.4%, 33.3%, and 66.6% in patients in groups 1, 2, and 3, respectively. Common surgical complications included bleeding, mental or perioral paresthesia, and malocclusion after MMA. Conclusion: The skeletal surgeries significantly improved some PSG parameters, and thus may be viable options for OSA treatment in Thai patients. Keywords: Obstructive sleep apnea, Skeletal surgery, Hyoid suspension, Genioglossus advancement, Maxillomandibular advancement, Thai

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